Note: One of the chapters of a book I wrote recently deals with sudden cardiac deaths in sports. I spent a lot of time studying the research on these deaths, and frankly, it isn’t encouraging. Many of these deaths occur in seemingly healthy athletes, and the rates of survival after the arrest is low. A friend sent me an article of a college football player who managed to survive due to the quick actions of the medical staff. I thought that I would write about the case for my latest newspaper column to demonstrate the importance of emergency action plans.Football game

Wofford linebacker Michael Roach collapsed near his team’s bench in the third quarter of the Terriers’ game at Tennessee Tech earlier this month. It would have been understandable to assume he was exhausted from playing 13 consecutive plays. But Roach was not breathing, and he lacked a pulse for 45 seconds.

His sudden cardiac arrest has a happy ending, but not every athlete is as lucky.

Incidence of sudden cardiac death in sports

Sudden cardiac death is the leading cause of death during sports and exercise. It’s also the most common medical cause of death among college athletes. A recent study of NCAA student-athletes found that roughly 1 in every 43,000 participants dies of cardiovascular causes each year. Basketball and football account for the majority of sudden cardiac deaths, although these deaths occur in swimming, lacrosse and cross-country as well.

Three out of every 1000 athletes have a cardiac condition that puts them at risk for sudden cardiac death. Hypertrophic cardiomyopathy, the condition ultimately discovered that caused Roach’s arrest, is present in somewhere between 1 in 800 to 1 in 2600 young athletes.

Hypertrophic cardiomyopathy and young athletes

Hypertrophic cardiomyopathy is a condition in which the heart’s muscle cells enlarge, resulting in thickened walls of the heart chambers. The heart can hold less blood and struggles to pump out blood during strenuous physical activity. An athlete with hypertrophic cardiomyopathy might notice chest pain, shortness of breath, dizziness or even fainting spells.

Unfortunately, athletes frequently have no symptoms to serve as warning signs of the potentially fatal condition. The sudden onset of cardiac arrest can be the first manifestation of hypertrophic cardiomyopathy in young athletes. Even scarier is the fact that only 5% of patients survive after going into cardiac arrest.

Michael Roach survived despite these difficult odds. After athletic trainers, team doctors and EMS quickly assessed and revived him, they took him to nearby Cookeville Regional Medical Center. Doctors there implanted a cardiac defibrillator.

The need for emergency action plans in sports

Every school and sports team should develop an emergency action plan to prepare for and respond to these rare cardiac emergencies. Roach’s case should serve as a model. In a school statement, the linebacker admitted, “I went into cardiac arrest and for approximately 45 seconds had AEDno pulse and was not breathing. The athletic trainers and doctors were in the right place at the right time to do what was needed.”

An emergency action plan can help everyone be in the right place at the right time. It guides the rapid response of not only athletic trainers and team physicians, but also coaches and teammates, to an athlete’s collapse. Part of that plan should include access to automated external defibrillators (AEDs), which improve survival rates for sudden cardiac arrest if used very quickly. Other components of an emergency action plan include notifying local EMS and starting CPR.

AEDs should be present at all sports venues

Since basketball, football, swimming and lacrosse have the highest risks of cardiac arrest, these venues should have AEDs in place so that doctors and athletic trainers can use them immediately should an athlete collapse.

Cross country, another sport with a risk for cardiac emergencies, presents a challenge for healthcare providers since the races and training are spread out over many miles. Athletes should train with teammates and carry cell phones to quickly notify the medical staff. Placing AEDs on carts and having spotters along the course can be important as well.

Michael Roach has returned to classes at Wofford. He isn’t playing football, although he might help the team as a player coach. He plans to attend law school one day. He would never have that chance without the preparation and quick action of his team’s medical staff.

Many thanks to Carrie Boan, who brought this event to my attention.

Note: A modified version of this article appears as my sports medicine column in the September 28, 2016 issue of The Post and Courier.

Drezner JA, O’Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, Price DE, Dimeff RJ, Bernhardt DT, Roberts WO. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: current evidence, knowledge gaps, recommendations and future directions. Br J Sports Med. 2016 Sep 22.

Wofford player who collapsed on field: ‘Football kind of saved my life’. By Mike McCormick September 6, 2016.

Update On Linebacker Michael Roach. Wofford Athletics. September 3, 2016.

Hypertrophic Cardiomyopathy. American Heart Association. July 6, 2016.

Harmon KG, Asif IM, Klossner D, Drezner JA. Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation. 2011 Apr 19;123(15):1594-600.